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Cooperative-Health-Report-2018.Pdf This report refers to the first edition of “The cooperative health report 2018: Assessing the worldwide contribution of cooperatives to healthcare”, an exploratory study conducted by Euricse in partnership with the International Health Co-operative Organization (IHCO), a Sector of the International Co-operative Alliance. Members of the project scientific committee are Carlo Borzaga (University of Trento/Euricse), José Carlos Guisado (IHCO, former President), Jose Pérez Arias (IHCO, Secretary General), Bruno Roelants (CICOPA), Michael Roy (Glasgow Caledonian University), Gianluca Salvatori (Euricse), Angelo Stefanini (University of Bologna) and Carlos Zarco (IHCO, President). The project research team includes Giulia Galera, Giulia Colombini, Michela Giovannini, Chiara Carini, Anna Berton and Emilio Vivarelli (Euricse). National Researchers who contributed to national case studies include Enzo Pezzini (Belgium), Adriane Vieira Ferrarini and Bruno Gomes de Assumpção (Brasil), Vanessa Hammond (Canada), Jean-Pierre Girard (Canada-Quebec), Akira Kurimoto (Japan), Millán Díaz-Foncea and Carmen Marcuello (Spain). Euricse and IHCO are grateful to all of the cooperative organizations that participated in the research by sharing data and materials on their projects and activities. This work would not have been possible without their support. 2 To the memory of † José Carlos Guisado. 3 EXECUTIVE SUMMARY The transformation of health care systems: Main trends and challenges To address people’s health needs, many nations have developed diverse types of health care systems. Country variations largely depend upon the level of public regulation of the related health activities, the financing mechanism and the degree of coverage for sickness and health problems. Furthermore, the nature and governance of the organizations managing the delivery of health services also impact the shaping of health care systems. The nations covered by this stage of our research exclude low-income countries, i.e. most African and some Asian countries, which lack health care systems altogether. Although the present research explores different types of well-structured health care systems, organizations supplying health services are significantly diverse; they include public, private non-profit, mutual, cooperative or private for-profit organizations. When considering the roles played by the different service providers, four typologies of health care systems have been identified. This way of classifying health care systems is meant to shed light on the complexity of the health care supply, particularly on the role played by health cooperatives and mutual aid societies. The systems identified are the following: Almost exclusively public health care systems with private actors, for-profits, non-profits and cooperatives covering a marginal function; Universal health care systems where public actors have integrated the pre-existing private mutual and non-profit organizations; Health care systems conceived to ensure public universal coverage, which have, however, failed to ensure access to health services to all population groups; and Mixed health care systems where only basic health services are ensured by public policies targeting low-income groups. In each health care system identified, the role of mutual aid societies and cooperatives tends to increase in importance over time. There is nonetheless a progressive shift from the first towards the fourth type, which can be interpreted as a reaction to the mounting difficulties all these systems are facing. Key problems and challenges faces by the health sector All systems analysed share a number of problems, which can be regarded as a consequence of the evolution of both the demand for and supply of health services. These include, among others, an increase in health expenditure to meet pressing health demands, i.e. demand for long-term care services due to longer life expectancy, which leads to increased rates of morbidity; the difficulties of most health systems to organize preventive care; long wait times for healthcare; and the general 4 difficulty to contain rising health costs. These common problems have, in turn, four main implications: A progressive and relatively selective reduction in health care coverage and increasing inequality among individuals and groups and between urban and rural areas; Increased user resource withdrawal through ticket imposition in the public health care systems and through the increased cost of private coverage and out-of-pocket expenditures in both public and private systems; More intense pressure on health care workers (especially medical doctors) to increase their productivity; and A growing gap between the demand for personalized services and standard health care provision, which calls for innovative organizational developments. Policy makers have so far been unable to propose clear and long-term solutions. The most widespread policy responses have been the decentralization from national to regional authorities and the growing valorisation of private providers as a consequence of the privatization of health care service delivery. However, the privatization of health care has primarily been implemented by favouring for-profit providers, while health cooperatives have been largely disregarded by policy makers. Overall, the potential of health cooperatives is still far from fully harnessed. Based on our research, there are three main reasons that help explain why their potential has been underestimated: The tendency not to differentiate among private providers and the assumption that for-profit actors perform better than public, non-profit and cooperative organizations—often assimilated by the public one—due to their higher efficiency. The complexity of the non-profit and cooperative supply of health care—particularly, the different forms, activities, sizes and features exhibited by this varied organizational landscape across the globe. This complexity makes it difficult to extrapolate and quantify the weight of non-profit health care-oriented organizations separate from generic ‘private’ organizations. The lack of reliable and complete data on the true relevance of these actors, especially on the capacity of health cooperatives to perform health services and address health needs. The progressive revival of health cooperatives If one considers the pressing need to counteract mounting difficulties faced by health care systems worldwide and the several market failures faced by the health domain, i.e. the inability to pay for services and the information asymmetry between insurers and the insured and between patients and physicians, neither the key role of health care cooperatives, nor their revitalization are surprising. Despite having been downsized during the construction of public health care systems, mutual aid societies and cooperatives never disappeared altogether, even in countries with universal public health systems. Meanwhile, in countries with mixed universal health care systems (consisting of public and private providers) health cooperatives have continued to serve their members over the past two centuries without interruption. 5 However, for a health cooperative revival to happen fully, health care authorities and related workers need to better understand the role, relevance and potential of health cooperatives. This was precisely the main goal pursued by the research project ‘Health care cooperatives and mutual aid societies worldwide: Analysis of their contribution to citizens’ health’, commissioned by the IHCO. IHCO research aims and outcomes IHCO and the European Research Institute on Cooperative and Social Enterprises (Euricse) agreed to jointly develop a multi-annual research initiative on the contribution of health care cooperatives to improve people’s health and wellbeing across the world. They aimed to publish an annual report containing—for a progressively growing number of countries—both quantitative and qualitative analyses of health care cooperatives and mutual organizations as well as the systems in which they operate. The first year of the research study focused on 15 countries, selected among those that have a structured health care system. These include Argentina, Australia, Belgium, Brazil, Canada, Colombia, France, Italy, Japan, Malaysia, Singapore, Spain, Sweden, the United Kingdom (UK) and the United States. For each of these countries, Euricse developed a profile focused on the main features of health care cooperatives vis-à-vis the health care system. In-depth case studies of these cooperatives’ main features were delivered in Belgium, Brazil, Canada, Italy, Spain and Japan. The research initiative investigated various types of cooperatives: cooperatives of health practitioners, mainly doctors; user/patient cooperatives; and multi-stakeholder cooperatives, but also other types of co-operatives, like agricultural cooperatives, which provide different types of health services. Research Methods The present research project was based on quantitative and qualitative methodologies. Data analysis was based on the collection, aggregation and synthesis of already existing data obtained through available statistical and research reports, scientific papers and online databases. We also relied on data directly provided by the selected organizations. The quantitative research was integrated by a case study analysis focused on six country studies, which allowed for a more in-depth analysis of both the universe of health cooperatives in each country
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